Provider Demographics
NPI:1205102514
Name:ALICEA RIVERA, AMALIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:
Last Name:ALICEA RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3093
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-3093
Mailing Address - Country:US
Mailing Address - Phone:787-961-3600
Mailing Address - Fax:787-961-3601
Practice Address - Street 1:GATSBY PLAZA
Practice Address - Street 2:30 CALLE PADIAL SUITE 210
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-3600
Practice Address - Fax:787-961-3601
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical